Prosthetic Joint Infections due to Staphylococcus Aureus and Coagulase-Negative Staphylococci

Abstract

Purposes

To evaluate the specific characteristics, outcome, and predictors of failure of prosthetic joint infections (PJI) due to S. aureus and coagulase-negative staphylococci (CNS) treated with open debridement and retention of the implant.

Methods

PJI due to S. aureus or CNS prospectively registered in a database from 1999 to 2009 were retrospectively reviewed. During the study period, 106 patients met the inclusion criteria. The mean follow-up period was 3.8 years and for at least 2 years in all patients. The failure rate was 23.6% (25 out of 106). The only variable significantly associated with failure in the global cohort was polymicrobial infection (38.7% vs. 17.3%, p = 0.024). Fifty-seven (53.8%) patients had an infection due to S. aureus and 49 (46.2%) due to CNS. Among S. aureus infections, 95% corresponded to primary arthroplasties while 98% of PJIs due to CNS were after revision arthroplasties (p<0.001). C-reactive protein was significantly higher in PJI due to S. aureus (9.5 mg/dl vs. 4.9 mg/dl, p = 0.007). The rate of methicillin-resistance (8.8% vs. 59.2%, p<0.001) and fluoroquinolone-resistance (15.8% vs. 34.7%, p = 0.005) was significantly higher in CNS infections. The global failure rate was higher in S. aureus infections (28% vs. 18.3. p = 0.26). In S. aureus infections, patients diagnosed within the first 15 days after joint arthroplasty (p = 0.031) and with bacteremia (p = 0.046) had poor prognosis. In CNS infections only the location of the prosthesis (knee 27.6% vs. hip 5%, p = 0.045) was associated with failure.

Conclusions

PJIs due to S. aureus were mainly in primary arthroplasties; they had a higher inflammatory response; and the strains were more susceptible to fluoroquinolones and methicillin than CNS infections. S. aureus infections had a higher failure rate than CNS infections, however, the difference was not statistically significant. There were few factors associated with failure and they were different in S. aureus and CNS infections.

Keywords

Prosthetic joint infection Debridement Staphylococcus aureus Coagulase-negative staphylococci Outcome Predictors

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References

Zimmerli

, Trampuz

, Ochsner

P.E.

Prosthetic-joint infections. N Engl J Med. 2004; 351(16): 1645–1654.

Darouiche

R.O.

Treatment of infections associated with surgical implants. N Engl J Med. 2004; 350(14): 1422–1429.

Segawa

, Tsukayama

D.T.

, Kyle

R.F.

, Becker

D.A.

, Gustilo

R.B.

Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am. 1999; 81(10): 1434–1445.

Tsukayama

D.T.

, Goldberg

V.M.

, Kyle

Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg Am. 2003; 85-A(Suppl 1): S75–S80.

Moran

, Masters

, Berendt

A.R.

, McLardy-Smith

, Byren

, Atkins

B.L.

Guiding empirical antibiotic therapy in orthopaedics: The microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention. J Infect. 2007; 55(1): 1–7.

Cobo

, Miguel

L.G.S.

, Euba

. Early prosthetic joint infection: outcomes with debridement and implant retention followed by antibiotic therapy. Clin Microbiol Infect. 2011; 17(11): 1632–1637.

Vilchez

, Martínez-Pastor

J.C.

, García-Ramiro

. Outcome and predictors of treatment failure in early post-surgical prosthetic joint infections due to Staphylococcus aureus treated with debridement. Clin Microbiol Infect. 2011; 17(3): 439–444.

Zimmerli

, Widmer

A.F.

, Blatter

, Frei

, Ochsner

P.E.

; Foreign-Body Infection (FBI) Study Group. Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. JAMA. 1998; 279(19): 1537–1541.

Senneville

, Joulie

, Legout

. Outcome and predictors of treatment failure in total hip/knee prosthetic joint infections due to Staphylococcus aureus. Clin Infect Dis. 2011; 53(4): 334–340.

10.

Ferry

, Uçkay

, Vaudaux

. Risk factors for treatment failure in orthopedic device-related methicillin-resistant Staphylococcus aureus infection. Eur J Clin Microbiol Infect Dis. 2010; 29(2): 171–180.

11.

Tattevin

, Crémieux

A.C.

, Pottier

, Huten

, Carbon

Prosthetic joint infection: when can prosthesis salvage be considered?

Clin Infect Dis. 1999; 29(2): 292–295.

12.

Aboltins

C.A.

, Page

M.A.

, Buising

K.L.

. Treatment of staphylococcal prosthetic joint infections with debridement, prosthesis retention and oral rifampicin and fusidic acid. Clin Microbiol Infect. 2007; 13(6): 586–591.

13.

Stein

, Bataille

J.F.

, Drancourt

. Ambulatory treatment of multidrug-resistant Staphylococcus-infected orthopedic implants with high-dose oral co-trimoxazole (trimethoprim-sulfamethoxazole). Antimicrob Agents Chemother. 1998; 42(12): 3086–3091.

14.

Marculescu

C.E.

, Berbari

E.F.

, Hanssen

A.D.

. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis. 2006; 42(4): 471–478.

15.

Byren

, Bejon

, Atkins

B.L.

. One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother. 2009; 63(6): 1264–1271.

16.

Schoifet

S.D.

, Morrey

B.F.

Treatment of infection after total knee arthroplasty by débridement with retention of the components. J Bone Joint Surg Am. 1990; 72(9): 1383–1390.

17.

Deirmengian

, Greenbaum

, Stern

. Open debridement of acute gram-positive infections after total knee arthroplasty. Clin Orthop Relat Res. 2003; 416(416): 129–134.

18.

Bernard

, Legout

, Zürcher-Pfund

. Six weeks of antibiotic treatment is sufficient following surgery for septic arthroplasty. J Infect. 2010; 61(2): 125–132.

19.

Sierra

J.M.

, García

, Martínez-Pastor

J.C.

. Relationship between the degree of osteolysis and cultures obtained by sonication of the prostheses in patients with aseptic loosening of a hip or knee arthroplasty. Arch Orthop Trauma Surg. 2011; 131(10): 1357–1361.